Annex 1. WHO clinical staging of HIV disease in adults, adolescents and children Source: Adapted from WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva, World Health Organization, 2007 (www.who.int/hiv/pub/guidelines/ HIVstaging150307.pdf). Adults and adolescentsa Children Clinical stage 1 Asymptomatic Asymptomatic Persistent generalized lymphadenopathy Persistent generalized lymphadenopathy Clinical stage 2 Moderate unexplained weight loss (<10% of Unexplained persistent hepatosplenomegaly presumed or measured body weight) Recurrent or chronic upper respiratory tract infections Recurrent respiratory tract infections (sinusitis, (otitis media, otorrhoea, sinusitis, tonsillitis) tonsillitis, otitis media, pharyngitis) Herpes zoster Herpes zoster Lineal gingival erythema Angular cheilitis Recurrent oral ulceration Recurrent oral ulceration Papular pruritic eruption Papular pruritic eruption Fungal nail infections Fungal nail infections Extensive wart virus infection Seborrhoeic dermatitis Extensive molluscum contagiosum Unexplained persistent parotid enlargement Clinical stage 3 Unexplained severe weight loss (>10% of Unexplained moderate malnutritionb not adequately presumed or measured body weight) responding to standard therapy Unexplained chronic diarrhoea for longer Unexplained persistent diarrhoea (14 days or more) than 1 month Unexplained persistent fever (above 37.5°C, intermittent Unexplained persistent fever (intermittent or or constant, for longer than one 1 month) constant for longer than 1 month) Persistent oral candidiasis (after first 6 weeks of life) Persistent oral candidiasis Oral hairy leukoplakia Oral hairy leukoplakia Lymph node tuberculosis Pulmonary tuberculosis Pulmonary tuberculosis Severe bacterial infections (such as Severe recurrent bacterial pneumonia pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteraemia) Acute necrotizing ulcerative gingivitis or periodontitis Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 x 109/l) or chronic thrombocytopaenia Unexplained anaemia (<8 g/dl), (<50 x 109/l) neutropaenia (<0.5 x 109/l) and/or chronic thrombocytopaenia (<50 x 109/l) Adults and adolescentsa Children Clinical stage 3 Symptomatic lymphoid interstitial pneumonitis Chronic HIV-associated lung disease, including bronchiectasis Clinical stage 4c HIV wasting syndrome Unexplained severe wasting, stunting or severe malnutritiond not responding to standard therapy Pneumocystis (jirovecii) pneumonia Pneumocystis (jirovecii) pneumonia Recurrent severe bacterial pneumonia Recurrent severe bacterial infections (such as Chronic herpes simplex infection (orolabial, empyema, pyomyositis, bone or joint infection, genital or anorectal of more than 1 month’s meningitis, but excluding pneumonia) duration or visceral at any site) Chronic herpes simplex infection (orolabial or Oesophageal candidiasis (or candidiasis of cutaneous of more than 1 month’s duration or trachea, bronchi or lungs) visceral at any site) Extrapulmonary tuberculosis Oesophageal candidiasis (or candidiasis of trachea, Kaposi sarcoma bronchi or lungs) Cytomegalovirus infection (retinitis or Extrapulmonary tuberculosis infection of other organs) Kaposi sarcoma Central nervous system toxoplasmosis Cytomegalovirus infection (retinitis or infection of HIV encephalopathy other organs with onset at age more than 1 month) Extrapulmonary cryptococcosis, including Central nervous system toxoplasmosis (after the meningitis neonatal period) Disseminated nontuberculous mycobacterial HIV encephalopathy infection Extrapulmonary cryptococcosis, including meningitis Progressive multifocal leukoencephalopathy Disseminated nontuberculous mycobacterial Chronic cryptosporidiosis infection Chronic isosporiasis Progressive multifocal leukoencephalopathy Disseminated mycosis (extrapulmonary Chronic cryptosporidiosis (with diarrhoea) histoplasmosis, coccidioidomycosis) Chronic isosporiasis Lymphoma (cerebral or B-cell non-Hodgkin) Disseminated endemic mycosis (extrapulmonary Symptomatic HIV-associated nephropathy or histoplasmosis, coccidioidomycosis, penicilliosis) cardiomyopathy Cerebral or B-cell non-Hodgkin lymphoma Recurrent septicaemia (including HIV-associated nephropathy or cardiomyopathy nontyphoidal Salmonella) Invasive cervical carcinoma Atypical disseminated leishmaniasis a In the development of this table, adolescents were defined as 15 years or older. For those aged less than 15 years, the clinical staging for children should be used. b For children younger than 5 years, moderate malnutrition is defined as weight-for-height <–2 z-score or mid-upper arm circumference ≥115 mm to <125 mm. c Some additional specific conditions can be included in regional classifications, such as penicilliosis in Asia, HIV-associated rectovaginal fistula in southern Africa and reactivation of trypanosomiasis in Latin America. d For children younger than 5 years of age, severe wasting is defined as weight-for-height <–3 z-score; stunting is defined as length-for-age/height-for-age <–2 z-score; and severe acute malnutrition is either weight for height <–3 z-score or mid-upper arm circumference <115 mm or the presence of oedema..